Provider Demographics
NPI:1114209939
Name:MELENDEZ, BRENDA LIZ (MSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LIZ
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1888
Mailing Address - Country:US
Mailing Address - Phone:787-549-3980
Mailing Address - Fax:
Practice Address - Street 1:CARR. 667, CALLE ESPIRITU SANTO
Practice Address - Street 2:PARCELAS 428
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-623-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8142104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical